Abstract:

Objective　To investigate the association of uric acid to albumin ratio (UA / Alb, UAR) with cardiovascular and cerebrovascular events in patients with chronic kidney disease taking peritoneal dialysis. Methods　The clinical data of 533 patients with stage 5 chronic kidney disease taking peritoneal catheterization at Affiliated Lianyungang Hospital, Nanjing University of Chinese Medicine from October 2017 to May 2024 were retrospectively collected. According to the optimal cut-off value of UAR obtained by the receiver operating characteristic curve (ROC), the patients were divided into a low UAR group (321 cases), including 175 males and 146 females who were 53 (45, 61) years old, and a high UAR group (212 cases), including 122 males and 90 females who were 59 (48, 66) years old. The t test, Mann-Whitney U test, and χ² test were used to compare the data between the two groups. The survival curves of cardiovascular and cerebrovascular events in the patients were drawn by the Kaplan-Meier method. The patients' survival rate was analyzed by the Log-Rank method. The independent risk factors were analyzed by the Cox regression. Results　The area under the ROC (AUC) of UAR was 0.726 (95%CI 0.681-0.772); the sensitivity was 49.10%; the specificity was 88.00%; the optimal cut-off value was 14.77. Taking UAR 14.77 as the optimal cut-off value, the patients were divided into a low UAR group (UAR<14.77, 321 patients) and a high UAR group (UAR≥14.77, 212 patients). The age, white blood cell (WBC), neutrophils (Neu), red blood cell (RBC), standard deviation of red blood cell distribution width (RDW-SD), alkaline phosphatase (ALP), uric acid (UA), and neutrophil / lymphocyte ratio (Neu/Lym, NLR) in the high UAR group were higher than those in the low UAR group, with statistical differences (all Ρ<0.05). The levels of lymphocyte (Lym), mean erythrocyte hemoglobin concentration (MCHC), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and albumin (Alb) in the high UAR group were lower than those in the low UAR group, with statistical differences (all Ρ<0.05). The Kaplan-Meier survival curve analysis showed that the incidence rate of cardiovascular and cerebrovascular events in the high UAR group was higher in than that in the low UAR group (Log-Rank χ²=11.498, Ρ<0.001). The incidence rates at 12, 24, 36, 48, and 60 months in the high UAR group were 21.4%, 39.1%, 56.2%, 74.7%, and 86.5%, respectively. The Cox regression analysis showed that high level of UAR (HR=1.042,95%CI 1.021-1.063, Ρ<0.05) and low level of ALP (HR= 0.998, 95%CI 0.997-0.999, Ρ<0.05) were the independent risk factors for cardiovascular and cerebrovascular events in the patients. Conclusions　UAR and ALP have certain value for predicting the occurrence of cardiovascular and cerebrovascular events in patients taking peritoneal dialysis. UAR can be used as a good predictor of cardiovascular and cerebrovascular events in patients taking peritoneal dialysis.

Key words:

Chronic kidney disease, Peritoneal dialysis, Cardiovascular and cerebrovascular diseases, Uric acid/albumin ratio

摘要：

目的　探讨尿酸/白蛋白比值（UAR）与慢性肾病（CKD）腹膜透析（PD）患者心脑血管事件发生的关系。方法　采用回顾性研究，收集2017年10月至2024年5月南京中医药大学连云港附属医院CKD5期首次接收腹膜置管术的患者533例，以患者UAR受试者操作特征曲线（ROC）最佳截断值为分界线，将患者分为低UAR组［321例，其中男175例、女146例，年龄53（45，61）岁］和高UAR组［212例，其中男122例、女90例，年龄59（48，66）岁］。采用t检验、Mann-Whitney U检验、χ²检验比较两组患者资料，Kaplan-Meier法绘制PD患者心脑血管事件生存曲线，Log-Rank法分析其生存率，Cox回归分析心脑血管事件发生的独立风险因素。结果　PD患者发生心脑血管事件UAR的ROC结果显示，曲线下面积（AUC）为0.726，95%置信区间（CI） 0.681～0.772，灵敏度为49.10%，特异度为88.00%，最佳截断值为14.77，以最佳截断值将PD患者分为低UAR组（UAR<14.77，321例）和高UAR组（UAR≥14.77，212例）。两组资料比较：高UAR组年龄、白细胞（WBC）、中性粒细胞（Neu）、红细胞（RBC）、红细胞分布宽度标准差（RDW-SD）、碱性磷酸酶（ALP）、尿酸（UA）、中性粒细胞/淋巴细胞比值（Neu/Lym，NLR）均高于低UAR组，差异均有统计学意义（均P<0.05）；淋巴细胞（Lym）、平均红细胞血红蛋白浓度（MCHC）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、白蛋白（Alb）水平均低于低UAR组，差异均有统计学意义（均P<0.05）。Kaplan-Meier生存曲线分析显示，高UAR组PD患者心脑血管事件发生率高于低UAR组（Log-Rankχ²=11.498，P<0.001）；高UAR组12个月、24个月、36个月、48个月、60个月心脑血管事件发生率分别为21.4%、39.1%、56.2%、74.7%、86.5%。多因素Cox回归分析结果显示，UAR水平升高（HR=1.042，95%CI 1.021～1.063，P<0.05）和ALP水平降低（HR=0.998，95%CI 0.997～0.999，P<0.05）均是PD患者发生心脑血管事件的独立风险因素。结论　UAR和ALP对PD患者心脑血管事件的发生具有预测价值，UAR可作为PD患者发生心脑血管事件的良好预测指标。

关键词:

慢性肾病, 腹膜透析, 心血管疾病, 尿酸/白蛋白比值